부산대학교 도서관

Many observational studies have consistently shown that high-flux haemodialysis (hf-HD) has positive effects on the survival and morbidity of uraemic patients when compared with low-flux haemodialysis, and mainly considering the results of Membrane Permeability Outcome (MPO) studies there is evidence favouring high-flux treatments. A further improvement in convective treatments is represented by the on-line modality. On-line preparation from fresh dialysate by a cold-sterilizing filtration process is a cost-effective method of providing large volumes of infusion solution. Randomized, controlled, large-sized trials with long follow-up in haemofiltration (HF) are unfortunately lacking, possibly suggesting the difficulties in performing these trials, mainly in providing the same urea Kt/V considered adequate in HD. On-line haemodiafiltration (HDF) is considered the most efficient technique of using high-flux membranes, and clearances of small solutes like urea are higher in HDF than in HF and of middle solutes like β‎‎2-microglobulin are higher than in hf-HD. Thus HDF, as a strategy based on simultaneous diffusive and convective transport, may combine the beneficial effects of diffusive standard HD with the possible advantages of convective HF. Five large, randomized controlled trials just concluded are inconclusive in definitively clarifying the impact of on-line HDF on chronic kidney disease stage 5 patient outcomes.